William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Catherine Burt Driver, MD

Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

What is polymyalgia rheumatica?

Polymyalgia rheumatica is a disorder of the muscles and joints characterized by muscle pain and stiffness, affecting both sides of the body, and involving the shoulders, arms, neck, and buttock areas. Patients with polymyalgia rheumatica are typically over 50 years
of age. Polymyalgia rheumatica is abbreviated PMR.

Because both polymyalgia rheumatica and giant cell arteritis sometimes occur in the same patient, both diseases are reviewed here.

What causes polymyalgia rheumatica?

The cause of polymyalgia rheumatica is not known. Recent
research has
indicated that genetic (inherited) factors play a role in who
becomes
afflicted with the illness. Theories have included viral
stimulation of
the immune system in genetically susceptible individuals. Rarely, polymyalgia rheumatica is associated with a cancer. In this setting, the cancer may be initiating an inflammatory immune response to cause the polymyalgia rheumatica symptoms.

What are symptoms and signs of polymyalgia rheumatica?

The onset of the illness can be sudden. A patient may have a
healthy
history until awakening one morning with stiffness and pain of
muscles and
joints throughout the body. These pains can lead to a sensation of weakness and loss of function. Sometimes there is also muscle tenderness. These symptoms persist and are often
accompanied by an intense sensation of fatigue. Some patients
notice a
gradual loss of appetite, weight, and energy. Depression can
occur.

How is polymyalgia rheumatica diagnosed?

The diagnosis of polymyalgia rheumatica is suggested by the history and physical examination.
The doctor frequently notes muscle tenderness and that the
motion of the
shoulders is limited by pain. The joints are usually not
swollen. However,
swelling of the small joints of the hands, wrists, and/or knees
can occur.
Blood testing for inflammation is generally abnormal, as
indicated by a
significant elevation in the erythrocyte sedimentation rate
(sed rate or ESR) and/or C-reactive protein. There
are no specific tests, however, for polymyalgia rheumatica and
X-rays are
normal. The diagnosis is based on the characteristic history of
persisting
muscle and joint pain and stiffness associated with
elevated blood tests for inflammation, such as the ESR. It is also not unusual for patients to have slight elevations of
liver blood tests.